COMMON INITIAL DOSING REGIMENS

• Start at 0.25 mg subcutaneously once weekly for 4 weeks. Titrate every 4 weeks to 0.5 mg, 1 mg, 1.7 mg, and finally to 2.4 mg weekly as tolerated.

MECHANISM OF ACTION

• Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It mimics the effects of endogenous GLP-1 by stimulating insulin secretion in response to elevated glucose levels, suppressing glucagon secretion, and slowing gastric emptying. These actions improve postprandial glucose control and reduce appetite, leading to significant weight loss.

COMMON SIDE EFFECTS

• Gastrointestinal: Nausea, vomiting, diarrhea, constipation, and abdominal pain are common, especially during dose escalation.

• Metabolic: Hypoglycemia when used in combination with insulin or sulfonylureas.

• Injection Site: Localized reactions, such as erythema or swelling.

• Other: Fatigue, dizziness, and mild elevations in serum lipase levels.

• Severe Effects: Rare but serious adverse effects include acute pancreatitis, acute kidney injury (often secondary to severe dehydration), and gallbladder disease (e.g., cholecystitis or gallstones).

CONTRAINDICATIONS

• Absolute: Personal or family history of medullary thyroid carcinoma (MTC), multiple endocrine neoplasia syndrome type 2 (MEN 2), or hypersensitivity to semaglutide or its excipients.

• Relative: Severe gastrointestinal disease, a history of pancreatitis, or significant renal impairment. Patients with gallbladder disease should be monitored due to the risk of gallstone formation.

NOTES

• Our formulations of semaglutide are available compounded with Vitamin B6 (to decrease nausea) or Levocarnitine (to help decrease muscle catabolism during rapid weight loss).

• All compounds are obtained from licensed compounding pharmacies certified by their respective State Boards of Pharmacy. All batches of compounded medications are independently tested to ensure quality, sterility, and concentration.

• We can also obtain non-compounded semaglutide (Ozempic®) for patients at a significantly higher cost.

MORE INFORMATION

• FDA Safety Data Sheet can be found here

• Tan HC. Efficacy and Safety of Semaglutide for Weight Loss in Obesity Without Diabetes: A Systematic Review and Meta-Analysis. J ASEAN Fed Endocr Soc. 2022 [PubMed Link]

• Rubino D. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021 [PubMed Link]

• Singh G. Wegovy (semaglutide): a new weight loss drug for chronic weight management. J Investig Med. 2022 [PubMed Link]

• O'Neil PM. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet. 2018 [PubMed Link]

• Ghusn W. Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Netw Open. 2022 [PubMed Link]

• Wilding JPH. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 [PubMed Link]

• Rubino DM. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022 [PubMed Link]

• Ryan DH. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024 [PubMed Link]

• Wadden TA. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021 [PubMed Link]